Posts Tagged ‘healthcare’

It’s no secret that the cost of healthcare in the United States is highest in the world, but overall quality is low among developed nations. The United States ranks 37th in the world according to the World Health Organization. As you probably know, just about all of the developed countries in the world but the United States have universal healthcare. Certainly the top ten do. While the debate on whether to go single-payer or continue for-profit is important, there is another way to drastically reduce healthcare costs that gets very little attention. Poor diet reportedly is a major contributor to the cost of healthcare in the United States.

This was graphically pointed out by a Harris County farmer at a Wednesday night group discussion at the Unitarian Universalist Fellowship of Columbus, Georgia. He provided some very interesting information from the Sustainable Food Trust. (Click on that link and you can read the report on The True Cost of Food Conference that was held in San Francisco.)

The report tells us the following:

Diseases related to poor diets in the United States account for 86% of healthcare spending.

Obesity annually costs taxpayers $2 trillion in healthcare spending.

About $5 billion is spent on reactions to food dye.

877 million pounds of pesticides are used each year by industrial agriculture.

Americans spend about 6 percent of their annual income on food now as opposed to 16 percent in 1960. European countries spend 9-15 percent.

The Government spends $153 billion annually on assistance programs to low-income earners, $75 billion of that in food stamps.

The market favors producing food on an industrial, unsustainable scale. “Sustainability,” in this context, means providing for the current generation without inhibiting the ability of future generations to provide for themselves.

So, the real cost of food is much more than the money you pay for it at the supermarket. For instance, your taxes pay for the $20 billion agricultural subsidies.

Just think about the social costs and dollar costs of things like rising healthcare costs, air pollution, water pollution, climate change, illegal immigration, allergens, and others.

So that’s what some believe is the problem. How about solutions. Our Harris County farmer listed these:

— Reward environmentally responsible food production.

— Use money from government subsidies, crop insurance, and food stamps to make sustainable food more available and accessible to the public.

You have to admit, cliché warning,that’s certainly food for thought. One thought I have is that there needs to be a national educational program to inform the public about the benefits of following a healthy diet.

One of the stands featuring locally grown produce at the Uptown Market on Broadway in downtown Columbus. The market is open Saturdays from 8 a.m. to noon.

So-called Washington gridlock appears to work for the top one percent of America. The economy is improving, and CEOs, top management, and professionals are raking it in. Not so, for most others. That’s probably why it continues, and there is no end in sight.

The average American has seen his income decline over the past few decades, while the affluent American has seen his income dramatically increase. The income gap between rich and poor is about as great as it was in the Gilded Age when the Robber Barons ran things. After an anarchist assassinated President McKinley, his successor, President Theodore Roosevelt, became concerned about a revolution and started reforms, things like anti-trust laws to break up the monopolies. The idea was to save American capitalism by reforming it.

President Franklin D. Roosevelt, who admired and wanted to emulate his cousin Teddy, took the same tact during the Great Depression, and for the same reason some historians report, to save American capitalism. While the Russian revolution of 1917 brought on the communist state and the dictatorship of the murderous Joseph Stalin, and the Great Depression set the stage for ruthless dictators Hitler and Mussolini to come into power in Germany and Italy, the United States elected a president that promised it a New Deal. He is the only president in American history to be elected four times to the office.

From about 1937 to 1947 income inequality dropped dramatically. This was brought about by highly progressive taxation and the strengthening of unions, according to an article in Wikipedia. “And,,” the article says,”regulation of the National War Labor Board during World War II raised the income of the poor and working class and lowered that of top earners.” The middle class was at its peak and a “relatively low level of inequality remained fairly steady for about three decades ending in early 1970s.”

No doubt, the one percent leaders understand the lessons of those times. When things get bad enough for the masses, they will revolt, maybe not violently in every case, but they will revolt. There are ways to keep and increase the income gap while preventing revolt, and at the same time funnel tax dollars into their enterprises. They have figured out how to game the system.

Conservatives, including the American Medical Association, fought the creation of Medicare with everything they had. President Lyndon Johnson was a master at getting Congress to do what he wanted and he pushed through Medicare. It was and is a very popular program and costs a lot less to administer – compare 3 percent to 20 percent – than private healthcare insurance.

Recognizing this fact, the healthcare industry’s leaders, for instance, obviously now understand that the majority of Americans want the government involved in providing healthcare. Why not give them tax supported programs, but under the healthcare industry’s terms?

A good example is Congress passing of the Medicare “B” drug plan. That plan doesn’t allow Medicare to negotiate prices, which could lower them, but it does help senior Americans pay for their drugs, which means that billions in tax dollars are funneled into the coffers of the pharmaceutical companies. The CEO’s of the top eleven global pharmaceutical companies were paid a total of $1.58 billion last year. The top salary was $40 million. Tax dollars paid a great deal of that.

Now, in spite of all the anti-Affordable Healthcare Act or “Obamacare” propaganda, guess who is not going to lose in that scenario? The program calls for mandatory insurance for all Americans. The lobbyists were successful in keeping out a government option healthcare insurance plan, That was the one sure way of lowering premiums. Only private healthcare providers will sell that mandatory insurance. Do the math.

You could say that maybe if we had thousands of philanthropic physicians like Grant Scarborough and those who support him, our country could provide affordable health care for all. Maybe we wouldn’t need single-payer or Medicare for all to solve the crisis of exploding costs and millions without healthcare insurance. Of course, that alone would not solve the problem.

Dr. Scarborough is Founder and Executive Director of Mercy Med. It’s a religiously inspired non-profit organization that provides healthcare for the poor. He and his paramedics treat anyone who walks in the door of his clinic in the former CB&T banch building on 2nd Avenue whether they have insurance or not. Speaking to the Rotary Club of Columbus, he said, “individuals come in and pay an average of 28 dollars and get over 300 dollars of health care. It’s a great deal.” If someone comes in who is making more than $45,000 a year, he’ll charge them 45 dollars for an office visit. What if you are homeless and can’t pay? No one gets turned away.

It’s also a great deal for hospitals with emergency rooms, because clinics like his save them millions of dollars. Many of those who use clinics like his would simply go to the hospital emergency rooms for their treatment if those clinics did not exists.

He is motivated by the lesson of the Good Samaritan parable that the Bible says was told by Jesus Christ. The Good Samaritan stopped to help the man who had been beaten and robbed. Took him to an inn and gave the innkeeper money to care for him, and said he would back and give the innkeeper more if more was needed. And Dr. Scarborough invites us to join him in his quest. He said, “I encourage you to get involved with us or with another ministry, or with another country, and consider, and then be kind to the poor by loving your neighbor.”

I said earlier that having thousands of doctors like Dr. Scarborough might solve our healthcare crisis. However, physicians ares only part of the picture. There are other elements involved, things like hospitals, labs, diagnostic centers, and pharmaceutical and insurance companies.

I asked the nurse assigned to me, “How many doctors are on duty tonight?” She replied , “Two.” That confirmed my suspicion that The Medical Center’s Emergency and Trauma Center was understaffed that night, Sunday, April 3, 2011. That suspicion had been formed when another nurse, the one assigned to triage, told me that wait times would probably be up to seven hours for some of the many people sitting in the ETC waiting room, and the average wait would be about five hours. Because I had a head wound and was on a blood thinner which could have increased the chances of internal bleeding, I didn’t have to wait that long. I got to see a doctor in about two hours from the time I signed in.

So, my impression was the ETC was like emergency rooms all over the country, overburdened and understaffed, but was it? In my opinion, that night, Sunday, April 3, 2011, it was. However, it was not a normal night. I learned just how abnormal it was when I posed a few questions to Marion Scott, who is Director of Communications for the Columbus Regional Medical System. I decided to let her speak for herself unedited. This is what she wrote to me.

On the night you were treated, staffing in the ETC was at the “best practice” standard as set by the national Emergency Nurses Association. Staffing ratio is one nurse to four patients. There were two emergency physicians in the ETC that evening; again, an appropriate staffing level under routine conditions. Residents from our teaching program do not routinely work in ETC. They do report to the ETC for duty when we call “trauma,” a designation indicating extraordinary and severe patient volume that increases staffing across clinical and non-clinical support areas. We typically have one to three trauma cases in a 24-hour period. In the 24-hour period during which you were treated, we had 20 trauma cases – seven to ten times the normal trauma volume. You also asked about the number of patients treated in the Emergency and Trauma Center who cannot pay for care. For our last full fiscal year, which ended June 30, 2010, 86 percent of the total patient encounters through the ETC were uninsured and 33 percent resulted in uncompensated care. The Medical Center’s total uncompensated care for last fiscal year was just over $32 million. As you and I have discussed, the greater issue related to emergency care is the number of people who use an emergency room for minor illnesses and injuries and for primary care. Approximately 40 percent of the patients treated in The Medical Center’s ETC could have been treated in a more appropriate setting, such as their physician’s office or an urgent care center. The result of inappropriate use of an emergency room is overcrowded emergency rooms with long waits, inefficient use of hospital resources and higher costs for patients and insurers. Also, many people treated in an emergency room for minor illnesses and injuries do not have a physician, or “medical home.” It is so important to have a physician with whom you can establish an ongoing relationship and who will understand your health and medical needs and provide continuity of care. There are no easy answers or quick fixes to these serious problems. We can address the issues through education, communication, and services to assist the uninsured in finding programs that might help them and to assist people without a physician in finding a medical home.

It’s Monday, so I have to live up to my promise to try to post something new. It can’t be long and involved though because I’m suppose to be taking it easy for a few days. You see, I fell Sunday evening and hit my head on the sidewalk which led to an interesting experience at the Columbus Medical Center emergency room. The CAT scan didn’t turn up anything bad, so I am back at home with a big bump on the back of my head and instructions on what to do following a concussion. The main instruction is that I should rest. I suppose number two is that I shouldn’t drive for 3 days. Anyway, it was an interesting and informative Sunday night in the emergency room of today. I’ll tell you why in a few days. Stay tuned.

That was certainly on the mind of medical school graduates at a graduation ceremony I attended at Sunrise, a Fort Lauderdale suburb. My grand-nephew, Dr. Gibson Gray, was one of the graduates from Nova Southeastern University. Keynote speaker, Florida U.S. Rep. Debbie Wasserman Schultz, told them about the healthcare changes she supports.

Being a good Democrat, she made it clear that she supports President Obama’s initiative for Congress to come up with a new health care plan. With costs going out of sight, and about 50 million Americans being uninsured, many believe something has to be done – not that everyone wants anything done, because some are making out like bandits with the system the way it is – but the sticking point is what will be done.

Rep. Schultz says any new plan has to ensure that no one will be denied coverage, that no policy should deny coverage because of pre-existing conditions, that no one can be excluded from coverage, and no one looses coverage because they changed jobs, and that the government offer an optional insurance plan. The insurance companies will, no doubt, spend many millions of dollars to kill the government option part of the plan. The government plan would provide competition by providing lower rates, and the private insurance companies would have to keep their rates down to sell any insurance.

This can and will be debated, but a lot of people believe that the plan will not really solve the problem because it will still rely on private insurers. Among those who believe it won’t work and who are for single-payer is the organization Physicians for a National Health Program. They believe that only single-payer can actually cause the change needed. They maintain the private insurance industry is the reason that health care in America has reached this critical stage. On their website, PNHP.org, Dr. Fred Silver of Florida says, “This is because private insurance bureaucracy and paperwork consume one-third (31 percent) of every health care dollar. Streamlining payment through a single nonprofit payer would save more than $350 billion per year, enough to provide comprehensive, high-quality coverage for all Americans.” Physicians for a National Health Program is a non-profit research and education organization of 16,000 physicians, medical students and health professionals who support single-payer national health insurance.

Naturally, health professionals are concerned about how healthcare reform will affect their careers, especially recent grads who owe hundreds of thousands of dollars in college loans. Some believe that if the government plan does lower physician compensation, it should pay off those loans. They have a good point.

It appears there is little doubt that Congress will come up with some sort of healthcare reform legislation. It also appears that the healthcare industry is going to cooperate, with health industry leaders pledging to reduce healthcare spending by $2 trillion over the next ten years. And the pharmaceutical industry has agreed to spend $80 billion over the next decade to lower drug costs. Reform is probably preferable to revolution, and, no doubt, many drug industry leaders would consider a single-pay system a revolution. It would be.

Doctor in St. Augustine, Texas giving Typhoid Innoculation in 1944, Photograph by John Vachon for the United States Farm Secuirty Administration

Recently, I went to Fort Lauderdale to see my grand-nephew Gibson Gray graduate from med school. It was very satisfying to see him get that diploma, and the family had a great time celebrating the event with a Ft. Lauderdale vacation, but the event also brought home the fact that he is going into a profession that is in trouble. That’s because healthcare in the United States is in trouble.

Americans are not satisfied with the state of healthcare; they list it right up there with the economy when asked about what concerns them most at this juncture in history. The keynote speaker at Gibson’s graduation took the issue head on and got a lot of applause for eome of the things she said, but she also got some pregnant silences for some of the other things. The subject is, as you know, very controversial.

Monday, I will be getting into the issues that she raised. Join me, and please don’t hesitate to give me your opinions. Just click the “comment” button and tell us how you feel.

This was a very special graduation season for me, and I attended a very special graduation and celebrated it in novel, and most enjoyable way. I’ll get around to the celebration in another blog post, but for now we’ll concentrate of the graduation and what medical professionals face in the future.

I said this was special graduation for me. It’s always special when a family member you have known from birth gets to put “Doctor” in front of his name. I flew from Columbus, Georgia to Ft. Lauderdale, Florida to attend the graduation of my nephew Gibson Gray – well, he’s actually my grand nephew since he is the son of my niece Janet Sue Gray – from the medical college of Nova Southeastern University.

As I sat with Gibson’s mom and dad, Janet Sue and Gordon Gray, his brothers, Schafer and Taylor, and his wife Catherine, I felt, with them, a great sense of elation. I mean, doing what it takes to become a physician is quite an achievement – and who doesn’t want to be able to say, “my son, the doctor,” or in my case, ” my nephew, the doctor” ?

It is a tremendous acheivement, considering all of the years of study, and the tremndous costs – the majority of medical students have to get student loans running into the hundreds of thousands of dollars – that it takes to get a medical degree.

Dr. Gibson Gray, Uncle Richard (me)

Well, by George, our Gibson did it, and we are all bursting with pride. He is not through yet, though. Now he has to do three years of residency in a hospital. He will get paid, but it is a very low salary, and he won’t be able to pay back any of the loan until he finishes that.

Naturally, he and his family, and all of the medical graduates and their families, are keenly interested in what will happen to healthcare in the United States. It’s for sure that something is going to happen. The American people put it at the top of their list of concerns about the future. Costs have gone out of sight.

The issue was not ducked at the Nova Health Professions Division graduation ceremony. It was squarely faced by Florida Democratic Rep. Debbie Wasserman Schultz, the keynote speaker. We’ll look at that it in a future post. Stay tuned.

Rev. Kim Jenkins sees it up close and personal everyday. She is a Baptist minister who administers the Open Door Community House in Columbus, which is backed by the United Methodist Church. She told me of a lady who admitted she had committed substance abuse. She said the woman said, “I have to get off the street. It’s just getting too dangerous out there. Violence is increasing; drug abuse is increasing. Please help me.” Rev. Jenkins said she started making calls and found a church that was willing to help her. Rose Hill United Methodist helped her get a job.

That is not always the case. She told me of one lady who came in shaking as she said that she was on crack and had lost her children who were all in state custody. She wanted shelter. Open Door was full. It only has 12 beds, all for women. Rev. Jenkins called other shelters in Columbus, Macon and Atlanta. Nobody would take her either because she was on crack and they didn’t have medical facilities to deal with that. Jenkins said she had to tell her, “There is nothing we can do for you.”

Guy Sims, Co-chair of Building Prosperity in the Muscogee County Area

And just how bad is the poverty problem in Columbus? Former Muscogee County School District Superintedent Guy Sims told me that the rate is 27 percent, which, he said, “is a lot higher than the national average.” Sims, who is in between jobs now that Beacon University is shutting down, is a co-chair of Building Prosperity in the Muscogee County Area. His co-chairs are James Blanchard and Betsy Covington. They, along with about 40 other business and professional leaders, are working to develop a plan to do something about the problem.

It took a little while to get Columbus leaders involved. They just sort of left coping with the problem up to service providers, places like the Salvation Army, Valley Rescue Mission, House of Mercy, and Open Door. That changed three years ago when the University of Georgia’s Carl Vinson Institue of Government issued a report showing poverty was the Chattahoochee Valley’s number one problem. She said that opened a lot of eyes and at least “the conversation started.”

Guy Sims, says, if anything, he is sure it is worse now, citing the worsening economy as a primary reason. And Jenkins says the demand for services at Open Door has increased this year and she is sure it is happening at the other shelters and sevice providers in the area. Many more people are seeking shelter than are getting it. There are 2 thousand homeless people in Columbus.

A banker told Jenkins four years ago that the mortgage crisis was coming and the homeless population would be increasing. That’s right, a Columbus banker saw the collapse in the home mortgage industry coming four years ago.

Why should we care about the homeless, the working poor, shelters that are full and can’t possibly keep up with the increasing demand? After all, shouldn’t every tub stand on its own bottom? Shouldn’t people pull themselves up by their own bootstraps?

Well, says Rev. Jenkins, besides the moral and biblical reasons for caring, self-interest should make us care. Poverty causes crime rates to go up and all of us have to pay for fighting crime. It costs us more when we go to the hospital because the hospitals have to charge us more to pay for all of those people that are converging on emergency rooms. Emergency room care is extremely expensive.

A report by Building Prosperity points out that if everyone over 25 in our area got a high school diploma, that would increase wages enough to add $168 million to the economy.

If they got college degrees, we are talking $692 million.

If the weekly wage rate in Columbus ($564) were brought up to the state average ($669) $10 million would be added to the local economy every week.

So there are practical reasons to care even if you are hard hearted. Fortunately, not everyone in Columbus believes in practicing social Darwinism.